Alcoholic Cardiomyopathy

During medical school, I had a choice of doing clinical rotations in the US or the UK. I chose the latter and spent one year in the West Midlands of England; I did core clinical clerkships (medicine, surgery, OB/GYN, pediatrics and psychiatry) with Birmingham University medical students. I also did infectious disease electives in Leicester, England, Glasgow and Edinburgh, Scotland for an additional 6 months with Leicester University and Glasgow and Edinburgh University medical students.

One of my patients on the medical wards was a 45 year-old male who was single and unemployed. He used to go to a pub, ask the barman to line up 9 pints of beer on the counter, then take bets that he could drink all 9 pints in less than 1 minute. He did this at least once a week for many years. He always won.

Periodically, when he felt fatigued and had shortness of breath he would come to our hospital and be admitted. His diagnosis and the price he paid for his bets was alcoholic cardiomyopathy and severe heart failure (cor pulmonale). The toxic effects of alcohol caused the muscles on both sides of his heart to weaken, so that his heart could not pump effectively. Alcohol also had a direct toxic effect on his liver-causing cirrhosis. We would treat him with diuretics, get him better, send him home and immediately he would go back to the pubs.

His face was gaunt and he appeared thin and malnourished, 5 feet tall. His skin had a bluish tinge. He had bilateral lower leg edema. In spite of his poor physical condition, he smiled.

He like me. One day while we were making rounds, he said: "do you like western novels?" I said: "yes." The next week he died, which was not unexpected, since less than 25% of patients with alcoholic cardiomyopathy who continue to drink survive 3 years.

About one month later, a box arrived on my doorstep. Inside were 50 western paperback novels. I didn't have time to read them, so I left them in the library of our house for future visiting medical students to enjoy.

I believe in fate, since I met my wife Sue on an OB/GYN clerkship-we delivered a baby together. Twenty seven years later, I still have friends in the UK from these rotations.